Using Digital Health Research to Overcome Health Disparities

March 4, 2014

Many of us care deeply about health disparities and are exploring new ways to reach the more vulnerable groups. These disparities include differences in incidence (new cases), prevalence (all existing cases), death (mortality), survivorship, and overall burden of health conditions that exist among specific population groups. They are found among different racial/ethnic groups and in certain communities and underserved groups, such as rural areas and older people. Why do these health disparities exist? The reasons are complex due to many factors, which include:

limited access to health care and health education

difficulty understanding and interpreting health information

not seeking out healthcare or health education programs because of fear, misunderstanding, or lack of culturally-tailored resources

One area worth exploring is technology. Mobile technology, such as smartphones and tablets, for example, may provide a solution to delivering and exchanging health information with “hard to reach” underserved populations. Many researchers, including myself, are exploring the trends in the use of mobile technology among racial and ethnic minorities. According to the Pew Research Center, African Americans and Latinos are more likely to use smartphones, which are also their primary means of accessing the Internet.

There is opportunity and challenge in using mobile technology, like smartphones, to address health disparities and meet the needs of underserved populations.

Opportunity: Although there is a common misconception that only high income, well-educated individuals own smartphones, the truth is that low-income minority populations—including a high percentage of Latinos—use smartphones regularly: 91% own a cellphone and more than half of U.S. adults own a smartphone. Clearly, mobile technology has become an integral part of the modern lifestyle and will continue to be such for decades to come.

Challenge: According to recent research I conducted on the utilization of a web-based intervention intended to improve colorectal cancer screening among rural women, only 24.6% logged onto the intervention website, and there was a significant decline in website usage over the course of the study.

Similar studies have found that website or app usability (including the design and content) significantly impacts how the user interacts with the technology intervention. The evidence shows that many mHealth (“mobile health”) interventions using websites, apps, and text messaging do not effectively engage the populations to which they are targeted.

How do we as health educators, health communications experts, and behavioral scientists leverage the widespread use of mobile technology to appropriately exchange health information so as to reduce health disparities?

Looking at this question from a health communications perspective, there are several applicable concepts that create a framework for best practices in mHealth:

Address differences in health literacy levels when creating mobile intervention content. More than half of Americans, regardless of income or education level, are affected by limited understanding of health information. Health literacy can be easily addressed by incorporating concepts such as including plain language, categorizing information, and using graphics to convey important messages.

Whenever possible, incorporate different languages, other than English, into mobile interventions to capture diverse audiences of non-native English speakers seeking health information for themselves or their families.

Design mHealth interventions to be relevant and meaningful to their target audiences. For the intervention to be used to help promote positive behavior change, it must be delivered in an acceptable and appropriate way to the targeted audiences based on their culture, values, and beliefs.

Appropriately evaluate mHealth interventions by assessing participant usability and usage. Study designs that get user feedback during the development phase are considered a best practice in evaluating and improving mHealth interventions in a short period of time to grant more positive, long-term results.

As you consider how and when to optimize your web-based health information for delivery over mobile platforms, it is important to first examine how these tools can be improved using the best practices I shared in this blog to create more sustainable impact on youth safety.

Dr. Fleisher served on an expert panel on health disparities research at the 6th American Association for Cancer Research Conference on the Science of Cancer Health Disparities in December, 2013, which inspired this blog post.